Characteristics of Students With Physical Disabilities from their Teachers’ Perceptions: a Study on the Conceptual Parameters of the International Classification of Functioning, Disability and Health

ABSTRACT:

As school is understood as a social nucleus, identifying how teachers characterize the disability of their students constitutes an important focus of research, since these conceptions shape the educational attitudes and the approaches available. The objective of this study was to identify how teachers characterize the physical disability of their students and discuss possible implications of the perceptive tendencies involved in this characterization. Nine students with physical disabilities aged between six and twelve years old and their teachers participated in this study. Diagnoses included Cerebral Palsy, Congenital Malformation and Myelomeningocele. The research was conducted in six Elementary Schools of the regular school system, located in the hinterland of the state of São Paulo, from November to December 2014. Data were collected through a semi-structured interview, whose script was developed based on three categories under the conceptual parameters of the International Classification of Functioning, Disability and Health, namely: functions and structures of the body, activity and participation, environmental factors. Data were analyzed through content analysis and statistical analysis. Content analysis showed a predominance of focus in the activity and participation category. However, the Chi-square test demonstrated that the difference was not statistically significant. Still, the study points to a perceptive movement of the teacher toward the biopsychosocial focus of functionality since it shifts the focus from bodily attributes to functionality and then considers the need to invest in Assistive Technology resources for the student’s successful school performance.

KEYWORDS:
Special Education; Disability; Performance

RESUMO

à medida que se compreende a escola como núcleo social, identificar como os professores caracterizam a deficiência de seus alunos constitui um importante enfoque de pesquisa, uma vez que essas concepções moldam as atitudes e as abordagens educacionais disponibilizadas. Este estudo teve por objetivos: identificar como os professores caracterizam a deficiência física de seus alunos e discutir sobre possíveis implicações das tendências perceptivas envolvidas nessa caracterização. Participaram deste estudo nove alunos com deficiência física com idades entre seis e doze anos e seus professores. Os diagnósticos abrangeram Paralisia Cerebral, Malformação Congênita e Mielomeningocele. A pesquisa foi realizada em seis escolas de Ensino Fundamental da rede regular de ensino, localizadas no interior do Estado de São Paulo, no período de novembro a dezembro de 2014. A coleta de dados ocorreu por meio de entrevista semiestruturada, cujo roteiro foi elaborado com base em três categorias sob os parâmetros conceituais da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, sendo elas: funções e estruturas corporais, atividade e participação, fatores ambientais. Os dados foram analisados por meio da análise de conteúdo e análise estatística. A análise de conteúdo demonstrou predomínio do enfoque na categoria atividade e participação. No entanto, o teste Qui-Quadrado demonstrou que a diferença não foi estatisticamente significante. Ainda assim, o estudo aponta para um movimento perceptivo do professor em direção ao foco biopsicossocial da funcionalidade uma vez que desvia o foco dos atributos corporais para a funcionalidade e passa a considerar a necessidade de se investir em recursos de Tecnologia Assistiva para o sucesso do desempenho escolar do aluno.

PALAVRAS-CHAVE:
Educação Especial; Deficiência; Desempenho

1 Introduction

Physical disability is defined as a complete or partial alteration of one or more segments of the human body, resulting in impairment of physical function, excluding aesthetic deformities and others that do not produce difficulties for the performance of functions (Procuradoria Federal dos Direitos do Cidadão, 2004). However, although this definition considers motor aspects of performance in life situations, the question of social influence in the identification of disability needs to be clarified, since it constitutes a powerful and active determinant in the process of the organization of social life, mobilizing efforts in different scenarios of knowledge construction, as it is proposed by the International Classification of Functioning, Disability and Health (ICF), which presents a definition of disability, considering both the medical definition and the social definition of disability (World Health Organization [WHO] 2013).

Omote (1997) emphasizes that there is no disability per se as a characteristic or endogenous-organic quality referring to a particular person. Disability only materializes as such through socially adopted criteria, structured from the social environment itself, from the requirements established by everyday activities and from the way in which others (audience) interpret and relate to differences.

On the other hand, it is clear that there is a significant difference in behavior or in the body of the person identified as a person with disability. However, this difference may be both the cause and the consequence of the process of identification, recognition and treatment of that person as a person with disability. Thus, disability does not exist as an independent phenomenon, since it is based on a multifactorial and dialectical system intrinsic to the dynamics of visualization and interpretation of differences (Omote, 1993).

The International Classification of Functioning, Disability and Health (WHO, 2011) defines disability as any loss or abnormality of a psychological, physiological or anatomical structure or function that generates incapacity for the performance of activity, within the standard considered normal for the human being, understanding the phenomenon in a balanced way between the social model and the medical model.

Understanding school as a social nucleus, identifying how teachers characterize the disability of their students constitutes an important research focus, since social conceptions shape the attitudes and educational treatments provided. And if this theme was important in the past, it is nowadays highlighted, since the school inclusion of students with disabilities requires a change in the environment to fill gaps between the student’s functional capacity and the demands of the tasks performed in the environment (Araújo, 1998). The understanding of the disability based on conceptions that consider the individual from the existing dialectic between biological and social factors is fundamental so that one can conceive the functionality and the participation of this individual in the social context in which he/she is inserted.

Scholars of the phenomenon, among them Goffman (1988), have emphasized that when the disability is understood as something that belongs to the individual and is represented only in the corporal limits, he/she is identified on the basis of his/her deviant characteristics, being recognized under the parameters established for the characterization of the category of disability to which he/she belongs. In this social dynamic of identifying disability, the person with the disability loses his/her individuality and ends up assuming the role of ‘disabled’ in the different social contexts, as it can occur in standardized school-based conducts, by category of disability, as discussed in the past (Omote, 1990). When this position is assumed, any person with physical disability, for example, is seen as having the same needs and possibilities as other people in this category, a fact that justifies the standardization of strategies, resources and treatments provided. It is very common to find in schools the resources and strategies designed for a particular student with a physical disability, being mistakenly used with another student also with physical disabilities, but with completely different characteristics, needs and abilities (Almeida, Valentini, & Berleze, 2009). The false idea of the uniformity of disability leads individuals with disabilities to play only roles designed for them, and in this way there is a narrowing of possibilities for human development and an insurmountable barrier condition (Araújo & Omote, 2005).

The proposal of school inclusion for students with physical disabilities is a vast field of possibilities for understanding and working with differences, as it redirects the focus of attention to the environment, and it is supported by the concept of disability resulting from the existing dialectic between biological factors and sociocultural environment. The focus on the environment necessarily implies considerations about functionality, taking into account the organic or psychic limitations, but, at the same time, seeking to understand the specific demands of the environment, the activities to be completed and the challenges of social relationships in their context (Farias & Buchalla, 2005). Thus, any proposal of work that looks at the functionality needs to move towards understanding the factors of the environment that may present themselves as facilitators or obstacles to be transposed by individuals who present deficits in body structure and function (WHO, 2011).

From the perspective of inclusive education, the need becomes evident, on the part of the educator, to seek specific knowledge and resources that help his/her practice, as well as his/her professional education. Thus, it is necessary for teachers to be able to teach with the same pedagogical goals, regardless of whether students have special educational needs or not. During the option of teaching strategies, there may be a need for curricular adaptations, in order to guarantee a service adjusted to the specificities of each student (Mendes, 2006; Capellini & Mendes, 2007). However, alternatives directed to the resources of access to the curriculum precede the change of the curricular content. In this perspective, when understanding that incapacity emerges from the relation between the functional capacity of the person and the demand of the environment (Verbruge & Jette, 1994; WHO, 2011), there is, in the Assistive Technology (AT), the fundamentals that guide practices to modify the inability to perform everyday tasks.

Researchers warn that when initiating the process of implementation of AT, it is necessary to know the users, their history, their needs and their desires, as well as identify the real needs considering all their social context and the possible barriers that limit their independence (Soro-Camats, 2003; Parette, Brotherson, & Huer, 2000).

However, the option or choice of resources and strategies appropriate to each student is closely linked to the teacher’s perception of the characteristics of the student, being the central question investigated in this research, of which the objectives are: a) to identify how teachers characterize the physical disability of their students; and b) to discuss possible implications of the perceptual tendencies involved in this characterization.

2 Method

This study presents a descriptive study design according to Triviños’s (1987) classification.

2.1 Participants

Nine students with physical disabilities aged between six and twelve years old and their respective teachers participated in this study. The medical diagnoses presented by the participating students were: seven students with Cerebral Palsy, one with Congenital Malformation and one with Myelomeningocele.

2.2 Inclusion and exclusion criteria

The inclusion criteria included the identification of students with physical disabilities by the register available in the Secretariat of Education of those who were enrolled in Elementary School of the regular network of education, excluding from this study students with associated hearing, visual and/or intellectual disorders.

2.3 Location and time period

The research was carried out in six elementary schools of the regular network of education, located in a municipality of the hinterland of the state of São Paulo. Data collection took place from November to December 2014.

2.4 Data collection instruments

The data were collected through an interview, whose script covered the conceptual parameters of the ICF and the activities of playing, doodling, using school supplies, self-caring and social activities.

The interview as a form of data collection was adopted considering that it is especially suitable for perception studies (Lenneberg, 1967), and it is feasible when the information necessary for the research is not registered or available, except in the thought or memory of the interviewee. When interviewing, the researcher engages in a process of interaction with the interviewee, since during the interview both the interviewer and the interviewee bring with them past experiences that will help the interaction (Manzini, 1991). According to Manzini (2003), the interview is, in essence, a form of social interaction that seeks information face-to-face.

The purpose of the interview was to identify the perceptive tendencies of the teacher when describing the student with physical disabilities under general aspects and under aspects of the functionality focused on the accomplishment of school activities. For this purpose, an interview script was drawn up, based on the conceptual parameters of the ICF, giving priority to the classification of responses in three categories defined a priori, namely: functions and structures of the body, activity and participation, and environmental factors, defined as follows:

• Functions and structures of the body: These are the physiological functions of organic systems (including psychological functions). Body structures are the anatomical parts of the body, such as organs, limbs and their components.

• Activity and participation: Activity is the execution of a task or action by an individual. Participation is the involvement of an individual in a real-life situation.

• Environmental factors: They constitute the physical, social and attitudinal environment in which people live and lead their lives. These factors are external to individuals and may have a positive or negative influence on their performance as members of society, on the individual’s ability to perform actions or tasks, or on the function or structure of the individual’s body.

The interview script was submitted to the appreciation of thirteen judges from the Graduate Program in Education who took the discipline Methodology using interview. In this stage of elaboration of the instrument of data collection, the script was evaluated as to its form and as to the distribution of the continuum of the questions.

After this appreciation, the pilot script was tested for its feasibility in a private school in a city located in the hinterland of the state of São Paulo, with three students from Childhood Education who had physical disability. After this experience of applying the interview script by the researcher, the work continued on the preparation of the final script with the appropriate adjustments according to the target population of this research.

The final script was constructed from three thematic axes corresponding to the research objective:

• Axis 1 - Characterization of students with disabilities under general aspects. This axis was to identify the teacher’s perception of his/her student with physical disability in three situations: when describing him/her, when expressing his/her knowledge about the student’s disability, and when indicating the student’s abilities and difficulties to the proposed activities in the school environment.

• Axis 2 - Characterization of students with disabilities under aspects of functionality in specific school activities (playing, self-caring, doodling and using school supplies and social function), taking into consideration the performance of the students. On this axis, teachers were asked how they described the students’ performance in relation to the mentioned activities considering the parameters of function and structure of the body, activity and participation, and environmental factors.

• Axis 3: Characterization of the participating teacher: The objective of this axis was to identify the teacher’s education, his/her experience in Special Education and career length.

2.5 Data collection procedures

For the selection of the participants, a request for authorization was sent to the Department of Education, and subsequently a list of the students with physical disabilities enrolled in cycle I of Elementary School and their respective schools was requested. A list of twenty five students with physical disability that met the inclusion criteria of this study was made available. From this pre-selection, a telephone call was made to the school principals, requesting a meeting in order to present the project with its objectives, procedures and schedule.

Of the twenty-five students with physical disabilities, nine were selected to participate in the research due to the acceptance of the school. After the authorization of the principals and their respective teachers, contact was made with the families of the selected students to make the necessary clarifications and, based on their willingness to participate in the research, the Free and Informed Consent Forms were sent to the families of the students.

The data collection took place in the schools of the students participating in the research, in a place and time previously scheduled according to the preference of the school board and teachers. The interviews took place individually and lasted for about thirty minutes. With the permission of the interviewees, the interview was recorded to be fully transcribed later. Nine interviews were conducted in which each teacher interviewed corresponded to a student with physical disability.

2.6 Analysis procedures

The analysis of the collected data occurred in two stages:

• Content analysis as recommended by Bardin (2011).

• Statistical analysis.

Through the content analysis, we tried to establish a relation of correspondence between the semantic structures and the psychological and sociological structures. After all, any objective analysis seeks to substantiate intuitive impressions and judgments through operations that lead to reliable results (Bardin, 2011). Still based on the author’s conceptions, the content analysis aimed to obtain indicators that allowed the inference of knowledge regarding the conditions of production and reception of the messages. Regarding the categorization of the content of the interview, this research was based on Bardin (2011) that defined category as a set, a group or a division that presents similar characteristics, but that differ by nature, and must be constructed in a way that the same element cannot be classified in two or more categories. In this study, the categories were defined a priori based on the concepts of the ICF, which are: functions and structures of the body, activities and participation, and environmental factors.

The content analysis began with the complete transcription of verbal statements with orthographic adjustments. Subsequent to the transcripts, the excerpts of interviews corresponding to the previously defined categories were identified, covering the answers to the questions of the axes: characterization of the student with disability under general aspects and characterization of the student with disability under aspects of the functionality in specific school activities. In the content analysis of the interviews, the objective of the research was taken into consideration, seeking the interpretation of the data obtained through verbal statements that were classified into the categories established for analysis (Bardin, 2011).

Considering the representativeness rule described by Bardin (2011), according to which the analysis can be carried out on a sample drawn from a totality, as long as the material to that is useful, the most part of the material collected and transcribed in this study was used when the researcher elaborated the categorization. The information that was disregarded for the categorization did not concern the pre-established objectives for the collection and analysis of the data obtained through the interviews.

The categories were previously established based on the research problematization and methodological approach, drawing from the theoretical definitions adopted by the World Health Organization, when presenting ICF, from which the categories were extracted. Only the excerpts contained in axes 1 and 2 of the interview script that addressed the information related to students with disabilities were categorized. Axis 3, which contained information related to teachers, was used to characterize participants from their transcription.

In order to reach methodological and conceptual rigor, as proposed by Carvalho (1996), the material collected and categorized by the researcher was sent to the analysis of two judges, the first being an Occupational Therapist, Msc and PhD in Education, identified as judge 1; and the second an Occupational Therapist, Msc and and doctoral student also in Education, identified as judge 2.

We also considered that, in order to verify the reliability of a categorization matrix, it is necessary to submit it to two codings that can be elaborated by an encoder in two different moments or by two or more groups of encoders that encode the material at the same time (Oliveira, Ens, Freire Andrade, & Mussis 2003). We opted, in this research, for the participation of two judges in order to categorize the material. Both received the material at the same time and had the same amount of time to perform the procedure.

The material categorized by the researcher was sent in its entirety to the judges’ appreciation in order to guarantee the reliability of the analysis. In addition to the categorization worksheets, the judges received a cover letter containing the following information: clarification of the research objectives and data collection procedures; definitions of each category and guidelines pertinent to completing the spreadsheets.

3 Results and discussion

After the analysis, the general agreement indexes were obtained, as recommended by literature, citing Carvalho (1996) for this study (Table 1).

Table 1
Index of concordance obtained by the judges' appreciation

Relationship between researcher and judges	Index of concordance
Researcher and Judge 1	87.4%
Researcher and Judge 2	91.6%

Source: Elaborated by the authors.

The indexes of concordance were analyzed for each of the interviews according to judges 1 and 2. Tables 2 and 3 show the results.

Table 2
Index of concordance of judge 1 for each interview analyzed

Judge 1	Total	Agreement	%	Disagreement	%
Student A	52	42	81%	10	19%
Student B	49	45	92%	4	8%
Student C	36	29	81%	7	19%
Student D	32	30	94%	2	6%
Student E	38	29	76%	9	24%
Student F	39	39	100%	0	0%
Student G	18	15	83%	3	17%
Student H	16	12	75%	4	25%
Student I	29	29	100%	0	0%
Total	309	270	87,4%	39	12,6

Source: Elaborated by the authors.

Table 3
Index of concordance of judge 2 for each interview analyzed

Judge 2	Total	Agreement	%	Disagreement	%
Student A	52	48	92%	4	8%
Student B	50	44	88%	6	12%
Student C	36	29	81%	7	19%
Student D	32	31	97%	1	3%
Student E	38	37	97%	1	3%
Student F	39	38	97%	1	3%
Student G	18	16	89%	2	11%
Student H	16	14	88%	2	13%
Student I	29	27	93%	2	7%
Total	310	284	91,6%	26	12,6

Source: Elaborated by the authors.

The statistical treatment of the data collected in the interviews with the teachers started from the frequency counting of the pre-established categories for analysis and content of the interviews. Subsequently, the contingency analysis was carried out in order to identify if there was a predominance of one or more categories when analyzing the transcripts of the teachers’ statements. Table 4 presents the frequency counting of the categorized verbal statements. In total, there were 309 excerpts categorized, with 77 classified under functions and structures of the body, 162 under activities and participation and 70 under environmental factors.

Table 4
Frequency counting of the categorized verbal statements

Student	Functions and structures of the body	Activities and participation	Environmental factors
A	10	26	16
B	15	21	14
C	12	14	10
D	8	19	5
E	8	22	8
F	9	22	8
G	4	14	0
H	0	11	4
I	11	13	5
Total: 309	77	162	70

Source: Elaborated by the authors.

After the frequency counting, the data were submitted to the Chi-square test. It is a non-parametric statistical method that can aid in the formulation of hypotheses based on nominal data. The analyzes were initially performed on the three categories of classification and afterwards the analysis was performed on each of the two category groups. Figure 1 shows the synthesized analysis.

Figure 1
Analyzes performed with the Chi-square test

The objective of this analysis procedure was to identify if, during the teachers’ accounts regarding their students with physical disabilities in the school, there was a prevalence of a category, which could suggest the parameters that led the teachers of this study to analyze the performance of students with disabilities. According to this reasoning, the statistical analysis contributed to answer the following questions: Would the answers be based on biological factors, in which the physical and emotional attributes of the child assume great importance to guarantee his/her participation and achievement of school activities? Or would teachers, when describing their students with physical disabilities, be guided by environmental factors, assuming that environmental changes, whether physical or attitudinal, could ensure the participation of students with physical disabilities? And finally, considering the biopsychosocial factors, teachers would analyze the participation and achievement of school activities considering the integration of biological and social factors as necessary to favor the performance of their students with physical disabilities?

The first analysis of the categorization of the interviews considered the proportion of each of the categories comparing them as three independent groups (Functions and structures of the body, Activities and participation and Environmental factors). Subsequently, with the same objective, a comparative analysis was carried out between the categories: Functions and structures of the body, on one side, and Activities and participation, on the other; Functions and structures of the body, on one side, and Environmental factors on the other; and, finally, Activities and participation, on one side, and Environmental factors, on the other.

Considering the categories Functions and structures of the body, Activities and participation and Environmental factors as independent groups, the results obtained using the Chi-square test were x² = 22.957, p = 0.1149 and 16 degrees of freedom. This result shows that there was no statistically significant difference between the categories, regarding the frequency found in each of them. Despite this result, we observed a predominance of the category Activities and participation in relation to the others (Figure 2).

Figure 2
Result of the analysis of the categories Functions and structures of the body and Activities and participation and Environmental factors

In view of this result, the contingency analysis of the categories was sought by grouping them into two independent groups for each analysis, in order to identify if there would be a different result than the one found in the analysis of the three categories concomitantly.

The first two categories analyzed were Functions and structures of the body, on one side, and Activities and participation, on the other. The results of x² = 12.849, p = 0.1172 and 8 degrees of freedom demonstrate that there was no statistically significant difference between the categories.

For the analysis of the categories Functions and structures of the body, on one side, and Environmental factors, on the other, the result of x² = 12.297, p = 0.1385 and 8 degrees of freedom, there was no statistically significant difference between the categories.

The last analysis corresponded to the categories Activity and participation, on one side, and Environmental factors, on the other, the Chi-square test, with the results of x² = 11.890, p = 0.1562 and 8 degrees of freedom, shows that no statistically significant difference was found between the categories.

Overall, the results showed that there was no statistically significant difference between the three categories surveyed, as well as in the analyzes of the categories divided into two groups. However, given the results (Figure 6), it can be seen that the category Activity and participation was preponderant. This suggests that the teacher took into consideration, preferably, the student’s participation and accomplishment of the activities in the school environment. Thus, it may be suggested that the teacher’s view in this study was more anchored in the biopsychosocial model of functionality, taking into account the integration of biological and social factors.

Table 5 presents the results of the analysis with the Chi-square statistical test.

Tabela 5
Results of the analysis with the Chi-square statistical test applied to the categorization of interviews

Independent groups	x2	p	Degree of freedom	Conclusion
Functions and structures of the body / Activities and participation / Environmental factors	x2=22.957	p= 0.1149	16	No statistically significant difference
Functions and structures of the body/ Activities and participation	x2=12.849	p= 0.1172	8	No statistically significant difference
Functions and structures of the body/ Environmental factors	x2=12.297	p= 0.1385	8	No statistically significant difference
Activities and participation / Environmental factors	x2=11.890	p= 0.1562	8	No statistically significant difference

Source: Elaborated by the authors.

4 Conclusion

This study demonstrated that the participating teachers showed a tendency of perception of students with physical disabilities supported by the biopsychosocial model of the disability, since they described the functionality taking into account in particular the participation of these students and the accomplishment of the activities in the school environment. Although the environmental factors have not been neglected, it is necessary to consider whether a change in the environment can favor activity and participation, and, in this sense, this study points to the importance of investing in efforts to prescribe AT as a favorable element of the performance of the student with physical disability.

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Publication Dates

• Publication in this collection
  Jan-Mar 2018

History

• Received
  29 Jan 2017
• Reviewed
  02 Aug 2017
• Accepted
  02 Aug 2017